Key result
Adding NOACs to dual antiplatelet therapy after acute coronary syndrome reduces recurrent ischemic events but increases the risk of major bleeding.
Why the study?
Does the addition of NOACs to antiplatelet therapy reduce recurrent ischaemic events in patients after acute coronary syndrome?
Does the addition of NOACs to antiplatelet therapy reduce recurrent ischaemic events in patients after acute coronary syndrome?
Adding NOACs to DAPT after ACS reduces ischemic events but increases bleeding, though NOACs may be safer than VKAs in ACS patients with atrial fibrillation.
Supports NOAC addition to DAPT post-ACS for fewer ischemic events despite higher bleeding; leaves open optimal use pending further trials.
Despite dual antiplatelet therapy (DAPT) including potent P2Y12 inhibitors, recurrent ischaemic events occur in a significant number of patients after acute coronary syndrome (ACS), warranting new antithrombotic strategies. Combinations of non-vitamin K antagonist oral anticoagulant (NOAC) with antiplatelet therapy have been tested in several large phases II and III randomised trials. Overall, current evidence suggests that the use of NOACs on top of DAPT after ACS reduces the rate of recurrent ischaemic events, albeit at the price of increased risk for major bleeding. In the particular field of patients with ACS and atrial fibrillation, NOACs may be associated with reduced bleeding complications compared with vitamin K antagonist. Further randomised trials evaluating low-dose NOAC combined with single antiplatelet therapy are warranted.
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Guedeney et al. (2018) conducted a review in Acute Coronary Syndrome. Non-vitamin K antagonist oral anticoagulant (NOAC) on top of DAPT vs. DAPT alone / Vitamin K antagonist was evaluated on Recurrent ischaemic events and major bleeding. Adding NOACs to dual antiplatelet therapy after acute coronary syndrome reduces recurrent ischemic events but increases the risk of major bleeding.
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